Breathe Easier

Sep 27, 2013
Managing asthma requires clinical understanding of treatment options. Express Scripts' specialist pharmacists help patients achieve healthier outcomes.
  • Medicaid
  • Asthma

If you have asthma, then you know the value of rescue medications – the inhaler that you use to help you catch your breath in an emergency.

The challenge is that a lot of asthma patients become overly reliant on rescue medications. We’ve found that sticking to a regular treatment regimen decreases the need to “rescue” oneself.

As we recently mentioned in this space, our researchers found that more than half (55.7%) of all Medicaid patients with asthma used only their rescue medication.

Need for Therapy Adherence

As a specialist pharmacist in the Express Scripts Pulmonary Therapeutic Resource Center, statistics like that concern me. Asthma is a chronic condition that – when inadequately controlled – is a major cause of hospitalizations. Patients who are adherent to their maintenance controllers have a 43% lower rate of hospitalization and 40% reduced risk for breathing exacerbations. About 60% of all asthma-related hospitalizations are attributed to nonadherence to maintenance controllers.

With so much evidence supporting the benefits of medication adherence, one would think compliance to asthma regimens would be high. Unfortunately, we find that many patients and caregivers often forget or do not fully understand the risks associated with nonadherence.

Value of Specialist Pharmacists

I recently talked to a woman whose daughter has asthma and had not filled her controller medication prescription. At a retail pharmacy, this gap would likely go unnoticed. But in the Pulmonary Therapeutic Resource Center, we are acutely aware of the significant risks of nonadherence.

I spoke to the patient’s mother to determine why her daughter was not using her controller medication consistently. She had concerns about using inhaled corticosteroids – the primary medication asthma guidelines recommend for treating asthma – on a regular basis. She preferred to use the inhaler only when her daughter “seems to need it” and lately, her symptoms had been under control.

Given my focus on patients with asthma, I know that many parents have concerns about medication use in children. It was important that I understand her reasons and address them in a way that would help get her daughter back on the needed medication without questioning the mother’s judgment.

Treatment Guideline Education

While steroid use is a common concern, I pointed out that controllers have a much more localized mode of action in the airways and do not have a widespread impact on the rest of the body. There was little risk of the medication accumulating and causing adverse effects for her daughter. I also explained how not using the medication regularly could result in significant worsening of her daughter’s condition, including airway remodeling – an irreversible alteration in structural cells and tissues in the lungs of patients with asthma, leading to obstruction of the airways.

I shared information from the asthma treatment guidelines to help her assess her daughter’s asthma control, including information on frequency of symptoms and rescue medication use, nighttime awakenings and interference with normal activities.

Value of a Therapy Plan

During the course of our conversation, the mother came to realize that the regular use of controller medications for her daughter’s asthma was safe and necessary. We also discussed more convenient options for her to obtain the medication, including home delivery.

When I am able to counsel patients to help them make a better decision about their health – or that of their loved ones – I see the true value of my work as a specialist. My colleagues and I have a degree of specialized expertise that often makes the difference between a patient being healthy or suffering from disease complications.

No person can be an expert in everything, but as a specialist pharmacist with expertise and dedication to one therapeutic area, my practice has an impact that may help save lives and improve health outcomes.

Author Bio

Don Smart, RPh
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